Pay no attention to the people behind the curtain

Tuesday, September 08, 2009

Paul Ryan: Still peddling scare-tactic lies about health care

by folkbum

I go back, time and time again, to what I have said before: There is no downside for the Republican minority and the conservative press to lying to the American people. It doesn't really matter how many times you point out the lies, or how many times you patiently explain the specifics of their wrongedness, they just keep doing it. Betsy McCaughey keeps getting on TV to offer some new and bizarre misreading of legislation; the rightbloggers keep reposting the same mistaken lists that show up in their inboxes; and Paul Ryan keeps getting editorial space in local newspapers to offer the same tired lies about the health care bill he opposes. (Reminder: The last major Paul Ryan post was here.)

Now, I have no beef with someone who legitimately disagrees about whether the reforms offered in the ubiquitous HR3200 and other Democratic proposals are the way to go. A person can say, reasonably, that they oppose offering subsidies to people who can't afford insurance or allowing the government to compete with private insurance companies through a public insurance plan option. (Those two things, among the most key reforms in the bill, both poll very well, even among Republicans--which should make Ryan at least think about whether he's going to be on the right side of history here.) I can make, I believe, a persuasive case for those and for other parts of the bill without pulling stuff out of thin air; I'd like to think principled opponents could do the same.

But can Paul Ryan? No. Here he is:

Wisconsinites have expressed a number of serious concerns with H.R. 3200, the Majority’s health care overhaul: millions of Americans would lose their current coverage and be dumped on a new government-run plan; Washington bureaucrats would seize unprecedented decision-making power over their health; and a struggling economy would be hit with painful new taxes and a debt burden that we simply cannot afford.

Okay, maybe he's hedging a little bit by saying that these are things "Wisconsinites" fear--although as we saw previously, Ryan seems not to worry about correcting his audience's misperceptions about the bill when expressed at town halls, so it is disappointing either way that Ryan offers up such pap in print.

Let's take them in order, though any regular reader of mine should already know the true answers to these questions and can probably write the rest of the post without me here. But for the newbies, and those in Ryan's Congressional office stopping by (hi, guys!), let's spell it out.

Millions of Americans would lose their current coverage and be dumped on a new government-run plan: There are so many bad assumptions here, I hardly know where to start. I'll make a list:

Every year, without reform, millions of Americans already lose their current coverage; anyone losing a job (something that happens more and more lately) or changing jobs; anyone with employers priced out of the insurance market or forced to choose a new, cheaper plan instead of pay 10% or 20% rate increases; anyone buying insurance individually who faces recision or can't get coverage because of pre-existing conditions. HR3200 actually helps all of those people find less expensive, more stable coverage.

Ryan assumes companies that now pay no penalty for dropping coverage but don't will suddenly rush to do it when there's a penalty applied.

Ryan discounts the additional incentives in the bill for small businesses, in particular, to offer coverage.

Those without employer-based coverage are not required to choose a "government-run plan," but can instead choose any plan from the Health Insurance Exchange, which comprises mostly private offerings.

The public option is not really so scary. The plan, though government-run, is no different from any other insurance plan, with legally enforceable contracts, minimum standards of coverage (for all levels of the plan, from basic to premium-plus), and, if Medicare is any guide, access to just about any doctor and coverage for nearly any procedure you could want (read the fine print, of course). But it will not, by law as spelled out in HR3200, offer something "less" than private plans.

Is that enough? Is it clear now how ridiculous it is to make the kind of assumptions he makes and demonize a plan that will be no different from a private plan--which is still available for purchase instead?

Washington bureaucrats would seize unprecedented decision-making power over their [I don't know whose--Wisconsinites? people on the public option insurance plan? the bureaucrats?] health: Again, most of us already have a bureaucrat making decisions about our health. For most of America, if HR3200 passes, that bureaucrat will still be the same private-sector pencil-pusher as always. However, again with Medicare being a guide, government bureaucrats are far less difficult to deal with than private ones: Medicare has fewer rejected claims, covers more claims more quickly, and requires far less paperwork and legwork than private plans. Seniors know this; that's why there are the not-at-all-apocryphal-but-quite-real protest signs out there, "Keep your government out of my Medicare." (Again, Paul Ryan needs to figure out if he's on the right side of history here.) Doctors know this, which is why nearly all accept Medicare patients. And the nice thing about HR3200 is its transparency: You know exactly who is setting the policy, exactly what the policy is, and whom to lobby to get that changed, if you want (Congress has confirmatory power over most of the people involved in developing and implementing coverage policy). When the private sector bureaucrats hike your rates and deny your claim, how transparent is the process?

A struggling economy would be hit with painful new taxes and a debt burden that we simply cannot afford: I will give Ryan the fact that HR3200 includes what are euphemistically called "funding mechanisms" but which are, in practice, taxes. HR3200's "funding mechanism" is a surtax on the top 1/2 of 1% of earners or so. This surtax is what funds a significant amount of the subsidy offered in the bill to those who cannot afford to buy insurance. (Some of that is also offset by eliminating waste and inefficiency in Medicare, and idea Democrats stole from the GOP platform; too bad they don't stand by it now.) But the bill actually scores almost completely deficit-neutral. It will add less than $7 billion in debt annually for the next ten years--and that only because scheduled increases in Medicare reimbursements are allowed to stand (in other words, no, there's no plan to cut doctors' pay under Medicare).

And the public option itself actually saves money. I found myself arguing this over the weekend at a couple of the righty blogs where people apparently have internalized a lot of the misinformation about the bill. The public option costs nothing to the taxpayer; the HR3200 is very clear in explaining (page 119, if you don't believe me) that this public insurance plan must be fully funded only by member premiums. To repeat: No Tax Dollars Pay For The Public Option.

The spending comes mostly, as noted above, in the form of help to those who cannot afford to buy their own insurance. This exists completely outside the public option insurance plan; people receiving the subsidy are free to choose any plan from the Exchange, just like us rich folk. And that's where the savings come in: The Congressional Budget Office, for example, suggests that the public option may be up to 10% cheaper to subscribe to than a private plan; the UnitedHealth-owned Lewin Group suggests it could be more than that. (This is the mechanism by which private plans will be forced to be more efficient, rather than continuing to pass paperwork costs on to their members.) The more robust the public option--i.e., the more people who choose it over a private plan--the more the likely savings among those receiving the subsidy and, thus, less cost to taxpayers.

There's one more thing Ryan does, later in his op-ed, that deserves notice. He writes, "Most of us simply can’t stomach handing over our [. . .] health care sector[] to the federal government." HR3200 does nothing of the sort. It does not nationalize, socialize, single-payerize, or annex in any way the health care sector. HR3200 does not put one single doctor or nurse or pharmacist in the employ of the federal government. It does not take over one single hospital, clinic, doctor's office, or Walgreens. It does not revoke the charters of any insurance companies, drug makers, or medical equipment manufacturers. On a scale of 1-10, with 1 where we are now and 10 someplace like the UK, where the government really does control the health care sector, passing HR3200 would not move us at all from 1. To suggest, as Ryan does here, that HR3200 gives the government control of health care is blatantly untrue. It's a lie. There's no other way to put it--and I'm sure Paul Ryan knows this and doesn't seem to care.

Look, HR3200 is not the bill I would have written were I in Congress. But it is, on the whole, not that bad. We could do worse. And yet Paul Ryan and his media enablers are making it out to be something it is not, a monster of a bill that will eat us whole or at least tell your grandma how and when to die. It isn't. Ryan knows, though, what I've said before: The only way to beat this bill is to lie about it. And he does.